Provider Demographics
NPI:1316380751
Name:ABBOUD, ELIA CHARBEL (MD)
Entity Type:Individual
Prefix:
First Name:ELIA CHARBEL
Middle Name:
Last Name:ABBOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W COUNTRY CLUB RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5225
Mailing Address - Country:US
Mailing Address - Phone:575-627-0535
Mailing Address - Fax:575-627-5590
Practice Address - Street 1:601 W COUNTRY CLUB RD STE 201
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5225
Practice Address - Country:US
Practice Address - Phone:575-627-0535
Practice Address - Fax:575-627-5590
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2021-0248208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery